Provider Demographics
NPI:1851332662
Name:RIDGEWAY FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:RIDGEWAY FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-634-0922
Mailing Address - Street 1:PO BOX 4589
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-4589
Mailing Address - Country:US
Mailing Address - Phone:276-956-5520
Mailing Address - Fax:276-956-3174
Practice Address - Street 1:6581 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-3278
Practice Address - Country:US
Practice Address - Phone:276-956-5520
Practice Address - Fax:276-956-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201-0040893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201004089OtherSTATE PHARMACY LICENSE
VA4839354OtherNCPDP